| NPI | 1295992006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 35755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029361-1) |
| 225100000X Physical Therapist (Licence: TN 8295) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2023-01-17 |